Provider Demographics
NPI:1104814417
Name:LIEBLER, FREDERICK BYRON (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:BYRON
Last Name:LIEBLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GLADES RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6461
Mailing Address - Country:US
Mailing Address - Phone:561-395-2626
Mailing Address - Fax:561-395-7026
Practice Address - Street 1:670 GLADES RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6461
Practice Address - Country:US
Practice Address - Phone:561-395-2626
Practice Address - Fax:561-395-7026
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME16158174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373658000Medicaid
FLF32212Medicare UPIN
FL50571YMedicare PIN